Investigation of pulmonary hemodynamics and chest X-ray findings in hypercapnic patients with pulmonary tuberculosis sequelae]

We investigated pulmonary hemodynamics and chest X-ray findings to explore pathophysiological significance of chronic hypercapnia in patients with pulmonary tuberculosis sequelae. One hundred and seven patients underwent examinations of blood gases and right cardiac catheterization. The patients were divided into two groups, according to arterial carbon dioxide tension under room air breathing (PaCO2). Group I (n = 35) was defined as 45 Torr or lower of PaCO2, and Group II (n = 72) was the hypercapnic group whose PaCO2 was over 45 Torr. In addition, spirometry was done in 34 patients of Group I and 68 of Group II. First, the values of blood gases, spirometry and pulmonary hemodynamics were compared between the two groups. Secondly, between 22 of Group I and 50 of Group II, the values of pulmonary arteriolar resistance (PAR) before and after 100% oxygen breathing for 10 minutes were compared. These comparisons were made by exploratory data analysis. Lastly, we described in all cases with five items of chest X-ray findings and the extent of each finding we had defined. The items were emphysematous change; fibrosis, bronchiectasis, and/or cavity (hereafter abbreviated as "fibrosis"); lung resection and/or atelectasis; pleural thickening; and thoracoplasty. We explored the items of X-ray findings which may relate to hypercapnia by ridit (abbreviation for "relative to an identified distribution") analysis. The results were as follows. (1) Hypercapnic patients tended to have severer restrictive ventilatory impairment and hypoxemia. Under an even level of arterial oxygen tension (PaO2), tissue oxygenation was not poorer in Group II than in Group I. (2) Hypercapnic patients tended to have more unfavorable pulmonary hemodynamics. More than half of them had pulmonary hypertension defined as 20 mmHg or higher of pulmonary artery mean pressure (PAm). Under an even level of PaO2, PAm was higher in Group II. Although 34 patients of Group II showed PaO2 over 60 Torr, 23 of them had pulmonary hypertension. (3) PAR after oxygen breathing was more likely to decrease in Group II than in Group I. (4) As any mean ridit was standardized and adjusted to 0.5 in Group I, the maximum was the mean ridit of "pleural thickening" (= 0.67), next "fibrosis" (= 0.65) in Group II. The above two items of X-ray findings, in which each mean ridit was higher than in any other item, were more influential on hypercapnia. We conclude as follows. (1) Pulmonary hypertension is severer in hypercapnic patients with pulmonary tuberculosis sequelae; it may be mainly attributable to hypoxic pulmonary vasoconstriction. (2) An important cause of chronic hypercapnia may be pathological changes such as "pleural thickening" and "fibrosis" seen on the radiogram.     

Investigation of pulmonary hemodynamics and chest X-ray findings in patients with pulmonary tuberculosis sequelae and obstructive ventilatory impairment

We investigated pulmonary hemodynamics and chest X-ray findings to explore significance of obstructive ventilatory impairment in patients with pulmonary tuberculosis sequelae. One hundred and two patients underwent examinations of blood gases, spirometry, and right cardiac catheterization. The patients were divided into two groups, according to forced expiratory volume in one second as the percentage of forced vital capacity (FVC), which was expressed as FEV1%. Group A (n = 38) had FEV1% of 55% or lower and Group B (n = 64), FEV1% above 55%. First, the values of blood gases and hemodynamics were compared between the two groups, regarding the percent predicted value of FVC as a covariate. Secondly, between 26 of Group A and 42 of Group B, the change of pulmonary arteriolar resistance (PAR) before and after 100% oxygen breathing for 10 minutes was compared. These comparisons were made by exploratory data analysis. Lastly, we described every case with five items of chest X-ray findings and the extent of each finding we had defined. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity; pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. We explored X-ray findings influenced on airway obstruction by ridit (abbreviation for "relative to an identified distribution") analysis, taking smoking status into consideration. The results were as follows. (1) The patients of Group A tended to show severer hypoxemia and tissue hypoxia than the patients of Group B. (2) The patients of Group A tended to show worse values of pulmonary hemodynamics than the patients of Group B. Under an even level of the arterial oxygen tension that was 60 Torr or lower, pulmonary artery mean pressure was higher in Group A than in Group B. (3) PAR after oxygen breathing was less likely to decrease in Group A than in Group B. (4) As any mean ridit was standardized and adjusted to 0.5 in Group B, every mean ridit of "emphysematous change" in Group A was the largest-0.63 in non-smokers, 0.74 in ex-smokers and 0.70 in current smokers. Therefore, "emphysematous change" was more influenced on airway obstruction than any other finding because of the largest mean ridit. We conclude as follows. Pulmonary hypertension is more serious in patients suffering from severe airway obstruction with pulmonary tuberculosis sequelae, and it may be attributable to reduction in capacity of anatomical pulmonary vascular bed rather than hypoxic pulmonary vasoconstriction. Pathological changes such as "emphysematous change" on the radiograph might be considered as an important cause of obstructive ventilatory impairment.     

Limits of chest X-ray investigation in the diagnosis of recurrent pulmonary tuberculosis

PURPOSE: To investigate the usefulness of chest X-ray investigation for early diagnosis of recurrent pulmonary tuberculosis. OBJECT: Patients who start re-treatment at Fukujuji Hospital from 1993 to 2003 due to the recurrence of lung tuberculosis after the completion of standard chemotherapy. METHOD: Chart review. RESULT: Deterioration of chest X-ray was not observed in 19.5% (8/41) of recurrent pulmonary tuberculosis, and in 4 cases even improvement of chest X-ray finding was observed. Sensitivity of chest X-ray in all recurrent cases was around 80 %, and this figure did not increase in smear positive recurrent cases. Sensitivity of chest X-ray for symptomatic recurrent cases was 92.3%, and that for non-symptomatic recurrent cases 60.0%, which is significantly lower than that for symptomatic cases. CONCLUSION: Sensitivity of chest X-ray for early diagnosis of recurrent pulmonary tuberculosis is not very high, and bacteriological examinations are more important irrespective of chest X-ray finding. Especially in non-symptomatic recurrent cases, usefulness of chest X-ray is considerably limited. Method and necessity of regular follow-up in non-symptomatic persons after successful tuberculosis chemotherapy should be re-considered.     

Improvement on chest X-ray findings after two months of antituberculous treatment

PURPOSE: To detect factors that affected the improvement on chest X-ray findings after two months of antituberculous treatment. METHODS: We assessed the chest X-ray findings of 72 patients with sputum culture positive to determine whether findings showed improvement after two months treatment with antituberculous drugs, and we compared the differences in disease status between the improved group (I group) and the non-improved group (N group). RESULTS: The I group consisted of 43 pts. and the N group consisted of 29 pts. The mean age in the N group was higher than that in the I group. There were no differences in sex or body weight. Though the mortality rate in the N group was 20.7% and that in the I group was 9.3%, it was not statistically significant. The erythema size of tuberculin skin test in the I group was larger than that in the N group. There were no differences in the type or extent of lesion on Gakkai classification between the two groups, and there were no remarkable blood biochemistry findings in either group. Though there were no differences in the rates of side effects or discontinuation of treatment, the incidence rate of complications in the N group was higher than that ih the I group. CONCLUSION: Older patients with complications and smaller erythema size of tuberculin skin test reaction showed a delay in chest X-ray findings improvement after two months of antituberculous drug treatment.     

尘肺并发肺结核的胸部CT表现分析

目的 探讨尘肺并发肺结核的胸部CT表现特点。方法 搜集2015年6月至2016年12月重庆市公共卫生医疗救治中心诊治的96例尘肺并发肺结核的住院患者,回顾性分析96例患者的临床及CT检查资料。对并发结核病变的发生部位、范围、形态、类型及并发其他脏器结核情况进行观察。结果 96例患者中,尘肺Ⅰ期1例,Ⅱ期23例,Ⅲ期72例。受累范围:多肺叶90例(93.8%)。发生部位:尖后段93例(96.9%),前段48例(50.0%),中叶或(和)舌段49例(51.0%),背段68例(70.8%),基底段53例(55.2%)。病变形态:斑片状影85例(88.5%),大片状影48例(50.0%),空洞64例(66.7%)[其中多发空洞占67.2%(43/64)],树芽征56例(58.3%),胸腔积液36例(37.5%),胸膜增厚72例(75.0%),纵隔淋巴结肿大85例(88.5%),纵隔淋巴结钙化58例(60.4%)。Ⅱ期尘肺患者薄壁空洞发生率为47.8%(11/23),高于Ⅲ期尘肺患者[15.3%(11/72)](χ ²=10.378,P<0.05)。Ⅲ期尘肺患者大片状影、树芽征、厚壁空洞、胸膜增厚、纵隔淋巴结肿大及钙化的发生率分别为59.7%(43/72)、69.4%(50/72)、56.9%(41/72)、83.3%(60/72)、93.1%(67/72)、69.4%(50/72),高于Ⅱ期尘肺患者[分别为21.7%(5/23)、26.1%(6/23)、8.7%(2/23)、52.2%(12/23)、78.3%(18/23)、34.8%(8/23)](χ ²值分别为10.061、13.541、14.489、9.224、4.051、8.808,P值均<0.05)。 结论 尘肺不同分期患者并发肺结核CT表现具有一定差异,以浸润灶为主,常伴有多发空洞、树芽征、胸腔积液、肺外结核等。     

Coincidence of malaria parasitaemia and abnormal chest X-ray findings in young Gambian children

Weekly surveillance of Gambian children aged less than 5 years for both acute lower respiratory infections (ALRI) and clinical malaria showed a high rate of coincidence between abnormal chest X-ray findings and high levels of malaria parasitaemia. Generalized interstitial X-ray changes were particularly associated with these cases of malaria parasitaemia. It is suggested that such ALRIs in these children may be attributable to malaria.     

胸片正常的支气管内膜结核15例临床分析

目的 探索胸片正常的支气管内膜结核的临床特征及早期确诊手段。方法 分析15例经纤维支气管镜(纤支镜)确诊的支气管内膜结核患者的临床表现、胸部X线(平片)及CT片、纤支镜检查结果。结果 15例中主要症状包括：咳嗽15例，气促5例，胸痛4例，发热3例，咯血2例，消瘦2例。15例的X线胸片正常。纤支镜检查示46．7％的病例有炎性浸润型病变，33．3％有增殖型病变，13．3％有溃疡型病变，6．7％有狭窄闭塞型病变。15例痰涂片行抗酸染色者中3例阳性，痰培养阳性1例；纤支镜刷片检查8例阳性，活组织检查7例证实为结核。结论 支气管内膜结核无特异性临床表现及胸部X线表现正常不能排除支气管内膜结核，确诊主要依靠纤支镜检查。对不明原因发热和呼吸道症状经积极治疗无效者，应怀疑支气管内膜结核而及时行纤支镜检查。通过镜下常规刷检找抗酸杆菌配合组织活检确诊率高。     

A case of eosinophilic pneumonia with diffuse reticular shadows and scattered nodular shadows on chest X-ray film--comparison of findings of chest X-ray and lung histology]

A 47-year-old woman was admitted to our hospital because of dry cough and throat discomfort. Chest X-ray film showed reticular shadows with Kerley B line and scattered nodular shadows. Blood examination revealed normal WBC count (5100/mm3) with eosinophilia (21%), negative CRP, elevated ESR (49 mm/l hr), normal IgE level and positive antinuclear antibody with speckled pattern. Skin tests and precipitating antibodies for common allergens were negative. Results of arterial blood gas analysis and respiratory function test were almost normal. Bronchoalveolar lavage fluid yields 85.7% eosinophils, which suggested eosinophilic lung disease. To establish the diagnosis, thoracotomy was performed and lung specimens were obtained from S3a and S8a. In the area of the nodule, the alveolar spaces were filled with eosinophils and mononuclear cells, with no evidence of vasculitis, granuloma or parasites. Alveolar spaces were almost preserved in residual areas. The walls of air ways, pleura and lobular septa were heavily infiltrated with eosinophils and mononuclear cells. Thus, open lung biopsy confirmed the diagnosis of idiopathic eosinophilic pneumonia. The areas of intraalveolar filling with eosinophils and mononuclear cells were found to correspond to the nodular shadows on chest X-ray film. The relationship between the findings of chest X-ray films and lung histology are discussed.     

A case of lung tuberculosis showing no chest radiograph findings with recurrent hemoptysis

A 59-year-old male was referred to our hospital because of hemoptysis. A chest X-ray film and 7 mm-slice CT scan showed no abnormal finding. Bronchoscopy revealed hemorrhage in the right upper bronchus (B1a) Bronchial lavage of the lesion was performed, but Mycobacterium tuberculosis was not detected. Because of repeated hemoptysis, he was admitted to our hospital. Right bronchial artery angiograph showed vascular hyperplasia in the peripheral part of the upper lobal branch, and this lesion was suggested to be a bleeding point. There were no vascular malformations. Thin slice (0.5 mm-thick) CT scan showed mild infiltrative shadow in the right upper lobe. After admission, sputa smear for mycobacteria and PCR for M. tuberculosis became positive, and he was diagnosed as pulmonary tuberculosis. After starting antituberculous chemotherapy, hemoptysis disappeared, and sputa smear and culture for mycobacteria converted to negative. This case suggests that lung tuberculosis should be suspected in patients having hemoptysis, even though they had no chest X-ray film abnormality.     

结核病发病学研究进展及对当前结核病防控的意义

结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染人体后,有两种不同的发病类型,即原发性结核病和原发后(继发性)结核病.本文重点回顾近几年结核病发病学的重要进展,包括以肺泡巨噬细胞、脂质体、泡沫巨噬细胞、肉芽肿等为结构特点的原发性结核病,在结核发病过程中所起到的保护性免疫作用,以及结核空洞...     

初治涂阴肺结核胸片复读结果与诊断质量多因素分析

目的 分析在我国结核病防治规划实施中,县级结核病防治机构登记的初治涂阴肺结核患者诊断质量和影响因素。 方法 按照2006年全国初治涂阴肺结核患者的登记率水平,抽取4个省,每个省选择1个地（市）,每个地（市）抽取2个县,采取整群抽样的方法,对各县抽取60例涂阴肺结核患者诊断时的X线胸片和收集患者有关临床资料。各县所有复读胸片经数码摄像后,采用国家级专家个人盲法复读和专家组复读。国家级专家包括结核病防治、结核病临床和放射专家各2位。国家级专家组由结核病防治、结核病临床和放射专家各2位组成。各小组和专家对X线胸片复读认为不符合活动性肺结核患者影像学改变者为过诊。并对所有过诊患者的影响因素（共14个变量）分别进行单因素及多因素logistic回归分析,探讨涂阴肺结核诊断质量与相关的影响因素。
结果 涂阴肺结核总过诊率20.78%（399/1920）,8个县X线胸片诊断的平均过诊率为10.83%（26/240）～32.50%（78/240）不等,各专家对胸片复核时,其复核后过诊率在10.21%（49/480）～33.13%(159/480）不等。所有的变量经logistic多因素回归分析,结果显示最终影响过诊的有胸片质量、性别、年龄、病例诊断医生、结核菌素检查、卡介苗接种史及患者来源7个因素。使涂阴肺结核过诊风险增加相关的因素包括：40岁～（OR=2.007,95%CI=1.165～3.535）及60岁以上（OR=1.710,95%CI=1.277～2.940）、女性（OR=1.941,95%CI=1.226～3.102）、门诊医生（OR=2.243,95%CI=1.793～4.27)、结核菌素检查史（OR=1.985,95%CI=1.106～3.564）、卡介苗接种史（OR=2.773,95%CI=1.023～7.515）、胸片质量丙（OR=2.402,95%CI=1.006～6.995）及胸片质量丁（OR=10.694,95%CI=2.348～62.596）;涂阴肺结核过诊风险减少的相关的因素包括：诊断小组诊断（OR=0.471,95%CI=0.440～0.643）、转诊（OR=0.521,95%CI=0.313～0.865）、集中推荐（OR=0.437,95%CI=0.206～0.927）。结论 我国涂阴肺结核过诊率较高,过诊的发生与多种因素有关。     

肺结核患者咯血责任血管及其相关胸部CT表现的分析

目的分析肺结核患者咯血责任血管及其相关胸部CT表现,以期提高支气管动脉介入栓塞(BAE)的治疗效果。方法收集我院2017年10月至2020年10月在本院行胸部CTA及BAE治疗的94例患者的临床及影像资料。总结肺结核不同胸部CT表现与咯血责任血管之间的关系。结果94例患者经CTA检查共发现187支咯血责任血管,其中支气管动脉(BA)124支,非支气管性体动脉(NBSA)63支(多位于肋间动脉及锁骨下动脉);DSA发现咯血责任血管192支,以DSA为诊断“金标准”,CTA对咯血责任血管的检出率为97.4%;35例(占37.2%)病灶周围可见支气管动脉分支局限性迂曲、扩张,供血支气管动脉平均内径为(2.0±0.7)mm;肺结核伴咯血患者胸部CT发现病灶多位于多肺叶,病灶以弥漫性分布为主,多无胸腔积液,此外伴空洞、钙化、支气管扩张及淋巴结钙化等,均与咯血责任血管来源无明显相关性(P>0.05),病灶性质、胸膜增厚程度及结核病灶与增厚胸膜之间关系与咯血责任血管来源明显相关(P<0.05),其中咯血责任血管来源于BA的肺结核伴咯血患者,病灶病变以增殖、渗出为主,邻近胸膜增厚程度多较轻微或没有增厚且增厚胸膜无或轻度黏连者居多,而咯血责任血管来源于BA合并NBSA的肺结核伴咯血患者肺部病变以纤维化为主,邻近胸膜增厚明显,且肺部病灶与增厚胸膜紧密粘连者居多。结论肺结核伴咯血胸部CT表现与咯血责任血管来源关系紧密,可通过胸部CT表现提示咯血责任血管是否源于NBSA,可帮助提高BAE的治疗效果。     

CT在涂阴继发性肺结核中的诊断价值

目的探讨CT对涂阴继发性肺结核的诊断价值。方法收集118例涂片阴性的肺结核可疑者,同时行X线胸片和CT检查,其中肺结核76例,非结核性肺病42例。采用盲法由诊断小组分别对X线胸片和CT进行阅读。采用受试者工作特征曲线(ROC曲线)评价两种诊断手段的优劣。结果按“可能性大”为诊断界点进行统计,则X线胸片诊断的敏感度为81.6%,特异度为61.9%,准确性为74.6%,阳性预计值(PV₊)为76.3%:阴性预计值(PV_-)为69.2%;CT诊断的敏感度为93.4%,特异度为88.1%,准确性为91.5%。阳性预计值(PV₊)为92.2%:阴性预计值(PV_-)为89.8%。X线胸片诊断的ROC曲线下面积(A_z)为(0.758±0.102),CT诊断的曲线下面积(A_z)为(0.958±0.043),X线胸片联合结核抗体、PPD进行诊断的ROC曲线下面积(A_z)为(0.833±0.071)。X线胸片与X线胸片联合诊断的曲线下面积比较有显著性差异,(P<0.05)。但均显著小于CT诊断的曲线下面积,(P<0.05)。结论CT在诊断涂阴肺结核诊断和鉴别诊断方面具有较高的应用价值。